Degenerative Disc Disease of L Spine

Client was sent to neurosurgeon due to significant subjective complaints.  MRI w/o contrast showed multilevel spondylosis w/element of congenital canan narrowing and a few endplate Schmorl's nodes.  L3-L4 has broad-based circumferential disc bulg w/desiccation; extraforaminal component on L abutting L L3root w/mild central canal stenosis - primarily congenital.  L4-L5 has disc desiccation, mild facet degeneration, small HNP eccentric to the R; deformity of R ventral thecal sac; some mass effect on R L5 root.  Mild canal stenosis & lateral recess narrowing.  Neural foramen is patent.  L5-S1 mild facet degeneration w/broad-based disc osteophyte complex eccentric to L. No stenosis, neural foramen patent.  He was tested positive for SLR on right and reflexes normal.

Subjectively, patient cannot stand upright, cannot lie flat but a few minutes, cannot sit straight up in chair or couch, has to sleep in recliner or propped up on couch.  Cannot urinate standing up due to back pain and leg weakness.  Pain 8-9/10 when trying to move about. Pain deep in R buttock w/radiation down outside of R leg to foot with banding across R foot.  Cannot walk heel/toe due to what appears to be poor balance and excessive pain.  Dr. had him press against his fingers up and down with great toe and said that determined he did not have foot drop and could walk on heels & toes (??!).  Surgery not recommended but rather P.T. and pain clinic. Dr. wrote Rx for Lortab 10 w/2 refills and dismissed. Patient has no insurance, unable to work, and depending on his mother for financial support & bills.  Indigent care approved and would cover surgery if indicated.

[helenlegs11]

There are 2 things that could show why there is pain as especially in the second (L5 ) there shows mass effect on that nerve root.   1. extraforaminal component on L abutting L L3root w/mild central canal stenosis and 2.  deformity of R ventral thecal sac; some mass effect on R L5 root. . . .  But I would not think that all of the symptoms described can be attributed to these scan results. Check out piriformis syndrome (PS) as another diagnosis. Regardless surgery would always be a last option and PT and pain clinic is a good start. Ask at the pain clinic about PS tho'